Effects of polyglactin mesh combined with resorbable calcium carbonate or replamineform hydroxyapatite on periodontal repair in dogs.

This study evaluates periodontal repair and biomaterial reaction following implantation of a polyglactin mesh with or without porous resorbable calcium carbonate (RCC) or porous replamineform hydroxyapatite (RHA) in conjunction with reconstructive surgery. Ligature- and surgically-induced interproximal periodontal defects of left and right mandibular premolar teeth in 7 dogs were used. Bilaterally, mesial defects of the 2nd, 3rd and 4th premolar teeth were treated with polyglactin mesh, polyglactin mesh and RHA, or polyglactin mesh and RCC, respectively. The polyglactin mesh, shaped according to the contour of the defect, was adapted to the experimental teeth; its coronal margin positioned immediately apical to the cemento-enamel junction. Gingival flap margins were adapted and sutured to cover the polyglactin mesh completely. Clinical healing was generally uneventful. The dogs were sacrificed to provide block sections for histologic evaluation at 1, 3, 6, 12, 26, 32 and 56 weeks following wound closure. Generally, cementum regeneration was observed beginning at week 6 in all groups. Bone regeneration was observed from week 3 in polyglactin mesh-treated groups, and from week 6 in polyglactin mesh+RCC or polyglactin mesh+RHA treated groups. Bone regeneration appeared enhanced in polyglactin mesh+RCC or polyglactin mesh+RHA treated defects at week 12 and 26, with little difference between the three experimental conditions at week 56. Polyglactin mesh degradation was observed at week 3 and appeared complete at week 12. The RHA did not appear to resorb, while the RCC was gradually replaced by bone from week 3. Within limitations of the study conditions, periodontal regeneration was observed following implantation of a polyglactin mesh with or without RCC or RHA in conjunction with reconstructive surgery. As a conclusion, there seems to be no significant difference in periodontal regeneration after 12 months of healing between the group treated with the membrane only, and the group treated with the membrane and the bone substitution material. Changes in connective fiber orientation over the 1st 12 weeks of healing may suggest that "fibrous encapsulation" observed in earlier studies may only represent a transient stage in periodontal regeneration.